Fishman, Jonathan,Fisher, Edward W
Publication date 28-10-2024
Poutoglidis, Alexandros,Forozidou, Evropi,Fyrmpas, Georgios,Vlachtsis, Konstantinos,Karamitsou, Paraskevi
Publication date 23-04-2024
Objective Transoral robotic surgery total laryngectomy is a promising procedure. We conducted a systematic review to study the indications, surgical techniques and complications of this procedure.
Methods We followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.
Results We concluded with 5 studies and 27 surgeries. The main indications of transoral robotic surgery total laryngectomy were selected recurrent laryngeal squamous cell carcinomas, dysfunctional larynx, and specific primary non-squamous cell carcinoma laryngeal cancers. The rate of pharyngocutaneous fistula was 20 per cent overall. In every reported cancer case, the specimen was excised within negative surgical margins. The average time of the procedure was 282.6 minutes.
Conclusion Transoral robotic surgery total laryngectomy is a safe procedure of high value. The preservation of strap muscles and hyoid bone as well as the sacrifice of less mucosa compared to the traditional technique reduces the risk of certain complications and improves the swallowing outcome.
Smith, Laura J,Pyke, Wesley,Wilkinson, David,Travers-Hill, Emma,Surenthiran, SS
Publication date 22-04-2024
Objective This study examines how psychological aspects of vestibular disorders are currently addressed highlighting any national variation.
Method An online survey was completed by 101 UK healthcare professionals treating vestibular disorders. The survey covered service configurations, attitudes towards psychological aspects and current clinical practice.
Results Ninety-six per cent of respondents thought there was a psychological component to vestibular disorders. There was a discrepancy between perceived importance of addressing psychological aspects and low confidence to undertake this. Those with more experience felt more confident addressing psychological aspects. History taking and questionnaires containing one or two psychological items were the most common assessment approaches. Discussing symptoms and signposting were the most frequent management approaches. Qualitative responses highlighted the interdependence of psychological and vestibular disorders which require timely intervention. Barriers included limited referral pathways, resources and interdisciplinary expertise.
Conclusion Although psychological distress is frequently identified, suitable psychological treatment is not routinely offered in the UK.
Asta, Beyza,Bozdemir, Kazım,Şahin, Mehmet İlhan
Publication date 16-04-2024
Objective To investigate alterations in middle-ear mechanics after type 1 cartilage tympanoplasty by comparing the ambient pressure absorbance values of the perforated tympanic membrane, normal tympanic membrane and cartilage-grafted tympanic membrane.
Methods Twenty patients diagnosed with non-suppurative chronic otitis media and 20 healthy controls were included. Pure tone audiometry and wideband tympanometry were performed once in the healthy controls and pre-operatively, one month and three months post-operatively in the patients.
Results Using wideband tympanometry, the patients’ three-month post-operative ambient pressure absorbance values were found to be similar to those of the healthy controls at low frequencies, while lower ambient pressure absorbance values were recorded at middle and high frequencies. Air–bone gap and ambient pressure absorbance values showed significant negative correlations at 1000 and 4000 Hz both pre- and post-operatively.
Conclusion Generally, the patients’ ambient pressure absorbance values were significantly lower at middle and high frequencies than those of the healthy controls. Post-operative wideband tympanometry is a practical tool for investigating the effects of a repaired tympanic membrane on middle-ear dynamics.
Williams, Isabelle J M,Chin Liu, Melanie,Navaratnam, Annakan V,Ferguson, Mark
Publication date 16-04-2024
Objective Nasal septoplasty is one of the most performed procedures within ENT. Nasal obstruction secondary to a deviated nasal septum is the primary indication for functional septoplasty. Since the coronavirus disease 2019 pandemic, waiting lists have increased and are now long. This study assessed patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery using the Nasal Obstruction Symptom Evaluation instrument.
Method Patients on our waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool to assess symptom severity.
Results Eighty-six out of a total of 88 patients (98 per cent) had Nasal Obstruction Symptom Evaluation scores of 30 or more. In addition, 78 (89 per cent) and 50 (57 per cent) patients were classified as having ‘severe’ or ‘extreme’ nasal obstruction, respectively. Two patients scored less than 30 and were classified as having non-significant nasal obstruction.
Conclusion The Nasal Obstruction Symptom Evaluation instrument is a quick and easy way to validate septoplasty waiting lists. In this study, two patients were identified who no longer required surgery.
Alzaid, Mohammad,Ramadhan, Mohammed,Abul, Ahmad,Karam, Mohammad,Alsaif, Abdulmalik,Stapleton, Emma
Publication date 15-04-2024
Objective To compare ultrasonography-guided drainage versus conventional surgical incision and drainage in deep neck space abscesses.
Methods The study was pre-registered on the National Institute of Health Research Prospective Register of Systematic Reviews (CRD42023466809) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Medline, Embase and Central databases were searched. Primary outcomes were length of hospital stay and recurrence. Heterogeneity and bias risk were assessed, and a fixed-effects model was applied.
Results Of 646 screened articles, 7 studies enrolling 384 participants were included. Ultrasonography-guided drainage was associated with a significantly shorter hospital stay (mean difference = −2.31, p < 0.00001), but no statistically significant difference was noted in recurrence rate compared to incision and drainage (odds ratio = 2.02, p = 0.21). Ultrasonography-guided drainage appeared to be associated with cost savings and better cosmetic outcomes.
Conclusion Ultrasonography-guided drainage was associated with a shorter hospital stay, making it a viable and perhaps more cost-effective alternative. More randomised trials with adequate outcomes reporting are recommended to optimise the available evidence.
Lodhi, Sirat,Dodgson, Kirsty,Dykes, Michael,Vishwanath, Veena,Bazaz, Rohit,Mathur, Sachin,Watson, Glen,Cartwright, Katherine,Pearson, Amy,Wearmouth, Deborah,List, Richard,Yates, Phillip,Dixon, Joanna,Puveendran, Arullendran,Wilson, Margarita,Watson, Katherine,Cullinan, Milo,Mentias, Youssef,Capper, Ruth,Jewes, Linda,Wallis, Sebastian,Hamilton, David,Adams, Brook,Khalid-Raja, Mamoona,Faris, Barzo,Khan, Maha,Linton, Stefan,Abrar, Rohma,Owen, Eloise,Bisbinas, Vasiliki,Ijaz, Ali,Lau, Kimberley,Timms, Sara,Bruce, Jack,Stapleton, Emma
Publication date 22-04-2024
Objective Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).
Methods The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.
Results The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.
Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology does not have to be positive, histology malignancy excluded, positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.
Conclusion The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.
Patel, Aman M,Patel, Rushi,Revercomb, Lucy,Cohen, David Avery,Tseng, Christopher C,Hsueh, Wayne D,Filimonov, Andrey
Publication date 22-04-2024
Background The timing of tracheostomy for intensive care unit patients is controversial, with conflicting findings on early versus late tracheostomy.
Methods Patients undergoing tracheostomy from 2001through 2012 were identified from the Medical Information Mart for Intensive Care-III database. Early tracheostomy was defined as less than the 25th percentile of time from intensive care unit admission to tracheostomy (time to tracheostomy). Statistical analysis for tracheostomy timing on intensive care unit length of stay and mortality were conducted.
Results Of the 1,566 patients that were included, patients with early tracheostomy had shorter intensive care unit length of stay (27.32 vs 12.55 days, p < 0.001) and lower mortality (12.9 per cent vs 9.0 per cent, p = 0.039). Multivariate logistic regression analysis found an association between increasing time to tracheostomy and mortality (odds ratio: 1.029, 95 per cent confidence interval 1.007–1.051, p = 0.009).
Conclusion Our analysis revealed that patients with early tracheostomy were more likely to have shorter intensive care unit lengths of stay and lower mortality. Our data suggest that early tracheostomy should be given strong consideration in appropriately selected patients.
Oremule, Babatunde,Saunders, Gabrielle H,Kluk, Karolina,"dElia, Alexander",Bruce, Iain A
Publication date 18-04-2024
Objectives Clinician acceptance influences technology adoption, but UK health professionals attitudes towards artificial intelligence (AI) in hearing healthcare are unclear. This study aimed to address this knowledge gap.
Methods An online survey, based on the Checklist for Reporting Results of Internet E-Surveys, was distributed to audiologists, ENT specialists and general practitioners. The survey collected quantitative and qualitative data on demographics and attitudes to AI in hearing healthcare.
Results Ninety-three participants (mean age 39 years, 56 per cent female) from three professional groups (21 audiologists, 24 ENT specialists and 48 general practitioners) responded. They acknowledged AIs benefits, emphasised the importance of the clinician–patient relationship, and stressed the need for proper training and ethical considerations to ensure successful AI integration in hearing healthcare.
Conclusion This study provides valuable insights into UK healthcare professionals attitudes towards AI in hearing health and highlights the need for further research to address specific concerns and uncertainties surrounding AI integration in hearing healthcare.
Kapoor Nerurkar, Nupur,Goyal, Sakshi
Publication date 12-04-2024
Objectives Maximum phonation time is a simple test used to assess glottic competency. Our objective was to evaluate any correlation between maximum phonation time and spasmodic dysphonia as adductor spasmodic dysphonia and abductor spasmodic dysphonia have an adductor and abductor overdrive, respectively.
MethodsA 3-year data-review was performed for patients diagnosed with adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia. Maximum phonation time was noted on the first visit and compared with a control group.
Results Average maximum phonation time in adductor spasmodic dysphonia, abductor spasmodic dysphonia and control group was 25 seconds, 9 seconds and 16 seconds. A significant difference was found for adductor spasmodic dysphonia and abductor spasmodic dysphonia. A receiver operating characteristic curve analysis between adductor spasmodic dysphonia and control groups showed a positive predictive value of 81.3 per cent, negative predictive value of 83.9 per cent, sensitivity of 79.6 per cent and specificity of 85.2 per cent. Level of evidence = 4.
Conclusion We recommend that maximum phonation time be added to the diagnostic armamentarium of spasmodic dysphonia. This correlation between maximum phonation time and spasmodic dysphonia has not been previously published.
Xin, Ying,Song, Weiming
Publication date 16-05-2024
Objective The purpose of this study is to analyse the effect of half canal wall down tympanomastoidectomy in the treatment of chronic otitis media or cholesteatoma.
Method In this retrospective study, the half canal wall down tympanomastoidectomy technique was used at our hospital for chronic otitis media or cholesteatoma removal in 265 adult patients, representing 271 operated ears, with an average follow-up time of 8.4 years.
Results The post-operative cavities were slightly wider and straighter in 91.9 per cent of the ears. Fifteen per cent of the patients needed cavity cleaning every six months, 25 per cent of them needed cavity cleaning every year and 60 per cent of the patients had a self-cleaning cavity. Only one patient with a cleft palate experienced cholesteatoma recurrence in the mesotympanum.
Conclusion The half canal wall down tympanomastoidectomy technique showed a low-recurrence rate and satisfying operative cavities. The half canal wall down tympanomastoidectomy technique is a good choice for middle ear surgery.
Elgendy, Ahmed,Khafagy, Yasser,Elzayat, Saad,Ali Elouny, Ali Gamal
Publication date 29-04-2024
Objective The study aimed to compare the applicability of classic lateral lamellectomy versus submucosal conchoplasty techniques in managing concha bullosa during and after functional endoscopic sinus surgery.
Methods The study randomly divided 56 patients with bilateral concha bullosa into two groups. One group of patients underwent the submucosal conchoplasty technique and the other group underwent the lateral lamellectomy technique. The study compared the intra-operative findings, including the time required for each technique, the amount of intra-operative bleeding and the post-operative endoscopic outcome of the middle meatus and middle turbinate stability.
Results Submucosal conchoplasty was significantly more time-consuming than the lateral lamellectomy technique (p = 0.001*). The difference in the intra-operative amount of bleeding was (p = 0.086*). The lateral lamellectomy group showed a higher rate of synechia formation in the middle meatus (p = 0.012*).
Conclusion Submucosal conchoplasty is a valid technique for managing concha bullosa with better post-operative endoscopic outcomes.
Moen, Christy M,Tailor, Hiteshkumar,Hammond, Siggi,Hay, Bruce,Peedika, Nimmi,McMurran, A E Louise,Choo, Xin Yin,Stewart, Murray
Publication date 30-04-2024
Background Oesophageal soft food bolus obstruction is a common presentation to emergency departments. Often these patients are given medication with little evidence of efficacy. Although many cases self-resolve, some require removal of the obstruction. Delay in removal can lead to complications such as oesophageal perforation and mediastinitis. Traditionally, removal was performed by ENT surgeons using rigid oesophagoscopy, but oesophago-gastro duodenoscopy offers a safer alternative that does not require a general anaesthetic.
Method The current performance, pathways and outcomes of patients attending emergency departments across three health boards in Scotland were reviewed.
Results In total, 313 patients admitted for oesophageal soft food bolus obstruction were identified. Mixed practice for a single common presentation was observed. In addition, it was found that the majority of patients are already managed by surgery and gastroenterology services with good outcomes and low morbidity.
Conclusion Patients presenting with soft food bolus obstruction should be referred to local surgery and gastroenterology services in the first instance.
Townsley, Richard,Tan, Jiak Ying,Edy, Elbert,Lim, Alison,McMahon, Jeremy
Publication date 25-04-2024
Objective The larynx is the second most prevalent subsite for head and neck cancer. Over half of head and neck cancer patients present with advanced disease. We report our regional practices for palliative intent laryngeal squamous cell cancer (SCC).
Methods Retrospective analysis of patients with laryngeal SCC treated with palliative intent, discussed at the regional head and neck multidisciplinary team meeting from July 2010 to June 2016.
ResultsA total of 65 patients were included, of whom 45 per cent had potentially curable disease but were not fit for curative treatment. Nine patients (14 per cent) underwent tracheostomy, with mean survival and hospital stay of 278 and 48 days, respectively. Four patients (6 per cent) underwent debulking surgery with mean survival and hospital stay of 214 and 1 days, respectively.
Conclusion All palliative treatment measures offered to patients can have an impact on survival and quality of life. Patients should be at the centre of the decision-making process and counselled on the potential impact of interventions.
Kornfeld, Belen,Kyang, Lee,Taha, Ahmed,McCloy, Rachael,Chin, Vanessa,Leavers, Brett,Floros, Peter,Earls, Peter,Forstner, Dion,Addison, Alfred,Crawford, Julia,Gallagher, Richard
Publication date 23-04-2024
Objective To analyse the rate of contralateral nodal metastasis in human papillomavirus (HPV)-associated oropharyngeal carcinoma and identify the patient cohorts that would benefit from bilateral neck treatment.
MethodsA retrospective cohort review was performed on 110 HPV-positive oropharyngeal carcinoma patients who underwent transoral robotic surgery and bilateral neck dissections from 2012 to 2022. The primary outcome was to investigate the pathological incidence and location of contralateral neck node metastasis.
Results The contralateral nodal disease rate was 12.7 per cent (n = 14), of which 2 patients (2 per cent) were occult findings, with comparable results between tongue base and tonsil sub-groups. The most commonly involved contralateral nodal station was level II (11 of 110 patients, 10 per cent). The presence of extra-nodal extension and multiple ipsilateral positive nodes was associated with increased risk of contralateral nodal disease.
Conclusion The incidence of contralateral nodal and occult disease in the studied cohort is low. The characteristics of patients who may benefit from bilateral neck treatment were demonstrated.
Hazir, Burak,Kemaloğlu, Yusuf Kemal,Eker, Alparslan,Düzlü, Mehmet
Publication date 25-04-2024
Objective This study aimed to evaluate rate of the COVID-19 disease, its severity, mortality rate and anxiety levels in subjects who underwent total laryngectomy.
Methods The subjects who underwent total laryngectomy were included in the study. The data were first obtained retrospectively and then a telephone survey was applied. Anxiety levels was evaluated by the Coronavirus Anxiety Scale (CAS).
ResultsA total of 54 subjects were included in the study. Nine (16.7%) males were reported to be infected with SARS-CoV-2. Five (55%) of them were hospitalized; 2 of them (22%) were taken to intensive care units, and one subject (11%) died. Although a tendency to increase risk of COVID-19 disease in the tracheoesophageal voice prosthesis users (23.1% vs 14.63%) was observed, statistically difference was not significant. The average total CAS score was significantly higher in those who had COVID-19.
Conclusion The data documented that people who underwent total laryngectomy developed more frequent and more severe COVID-19 disease and had a higher mortality rate. Although no obvious variable was found, our data suggest that using a tracheoesophageal voice prosthesis may be somewhat effective. Besides, our subjects presented very low anxiety about COVID-19.
Youssef, Ahmed,Milton, Austin,Patel, Rusha,Mhawej, Rachad,Vasan, Nilesh,Krempl, Greg
Publication date 24-04-2024
Objective This study aimed to solve the debate over the role and extent of neck dissection to treat any occult nodal metastasis in patients undergoing salvage laryngectomy for recurrent and/or residual squamous cell carcinoma of larynx.
Methods This was a retrospective study over a time frame of 6 years (2016–2022) of 74 patients who underwent bilateral neck dissection and salvage laryngectomy for recurrent or persistent disease with N0 neck. We calculated the incidence of occult nodal metastasis in ipsilateral and contralateral neck.
Results Incidence of ipsilateral neck disease was calculated as 8.11 per cent and it was 0 per cent in contralateral neck. Regarding ipsilateral nodal level distribution, level II was the highest at 6.76 per cent, followed by level III at 5.41 per cent. There was 0 per cent metastasis in levels IV and IIb.
Conclusion In patients undergoing salvage laryngectomy with N0 neck, ipsilateral super selective neck dissection is considered a convenient and oncologically safe option to treat the neck.
Lau, Kin Lun,Ouma, Luke,Whitehead, Lou,Mukherjee, Aritra,Cocks, Helen
Publication date 02-05-2024
Objective In this study, we reviewed the post-operative complications in parotidectomy and its association with various patient, tumour and surgical factors.
Methods All parotidectomies performed in our regional unit between 2013 to 2020 were identified. Electronic medical record and clinic letters were reviewed for any post-operative complications. A logistical regression model was applied on data collected on twelve patient factors, three tumour factors and four surgical factors.
Results379 cases of parotidectomy were identified in the eight-year study period. 55% (n = 210) were documented with nine types of post-operative complications. This study identified age >80 (odds ratio = 1.89, p = 0.018), active smoker (odds ratio = 0.94, p = 0.018), total parotidectomy approach (odds ratio = 1.77, p = 0.012), longer operation time (odds ratio = 0.006, p = 0.015) and hypertension (odds ratio = 1.23, p = 0.019) were associated with a higher risk of facial nerve palsy. Predictive factors were also identified for auricular nerve numbness and Frey syndrome.
Conclusion This study revealed the incidences and potential predictors of post-operative complications in parotidectomy. Notably, the grade of operator (consultants/ registrars) had no effect on the possibility of adverse outcome, reflecting patient safety was not compromised for training. These findings can be used in patient counselling and guide treatment options to minimise post-operative complications.
Lancaster, Amelia,Salih, Ahmed,Tolley, Neil
Publication date 30-04-2024
Objectives Otolaryngology (ENT) plays a crucial role in healthcare, yet undergraduate education in the United Kingdom has historically not reflected this. This study aimed to assess the delivery of ENT education, focusing on teaching methods, clinical placements, and assessment practices.
Methods An online questionnaire was distributed to medical students. Data were collected via Qualtrics from 5 August 2023 to 17 October 2023.
Results Forty medical schools were involved. Thirty-seven schools had compulsory ENT teaching however 20 per cent lack an ENT placement. Clinical placements varied, with an average length of 7.3 days. Assessment of ENT knowledge included Objective, Structures, Clinical Examination stations (90 per cent) and written exams (80 per cent).
Conclusion The study highlights persistent gaps in ENT education. Deficiencies in clinical exposure and lack of alignment with national guidelines indicate the need for improvement. As the Medical Licensing Assessment approaches, standardising assessments may address disparities but should be accompanied by comprehensive changes in teaching methods and placements.
Publication date 28-10-2024
Publication date 28-10-2024